Panel Advises Flu Shots for Children Up to Age 18

The recommendation expands by about 30 million the number of children who should get annual influenza shots.

LAWRENCE K. ALTMAN

All children ages 6 months to 18 years in this country should receive an influenza shot every year, a federal advisory panel said on Wednesday.

The recommendation expands by about 30 million the number of children who should get annual flu shots. Current pediatric recommendations call for influenza vaccinations for children ages 6 months to about 5 years.

In expanding the new upper age limit to 18 years, the aim is to reduce both the time children and parents lose from visits to pediatricians and missing school and the need for antibiotics for complications, said Dr. Anne Schuchat, who directs the disease agency’s program on immunization and respiratory diseases.

An added expected benefit would be indirect — to reduce the number of influenza cases among parents and other household members, and possibly spread to the general community.

The recommendation, which is voluntary, was made by the Advisory Committee on Immunization Practice, which advises the Centers for Disease Control and Prevention in Atlanta. The C.D.C. and its parent, the Department of Health and Human Services, generally follow the advice of the committee, which is composed of vaccine experts from academia and the private sector.

The committee voted unanimously that the expanded immunization should start as soon as possible, but no later than the 2009-10 flu season. The centers expect that the vaccine industry, which made 132 million doses available this year, will be able to produce a sufficient supply in future years.

Every state but one has reported widespread influenza this winter. In Florida, activity is regional. Last week, the centers reported that 22 children had died in this influenza season.

The C.D.C. has long urged older adults and those with chronic ailments to get influenza shots each season.

In 2004, following the advisory committee’s recommendation, the centers urged that all infants ages 6 months to 23 months receive flu shots to protect them from serious complications of the viral illness. Hospitalization rates among the infant group rivals those among elderly Americans.

In 2006, the centers expanded the recommendation to include children ages 24 months to 59 months to provide them direct protection against influenza infection.

For initial protection, children ages 6 months to 9 years require two doses of flu vaccine, at least one month apart, the committee said. Then they should receive annual shots.

In a new study reported at Wednesday’s meeting, Dr. David K. Shay, who led a team from the C.D.C. and eight state health departments, found that full immunization against flu provided about a 75 percent effectiveness rate in preventing hospitalizations from influenza complications in the 2005-6 and 2006-7 influenza seasons. (The 75 percent rate could range, according to a standard statistical measure known as confidence intervals, from 41 percent to 91 percent.)

The study, which involved children ages 6 months to 23 months who had laboratory confirmed cases of influenza, will continue through this flu season. Because this season seems to be more severe than the last two, the researchers expect to have more cases to analyze and improve the statistical odds.

Vaccines are typically designed to protect against the three strains of influenza. Experts determine the strains based on data from current seasonal transmission and their judgment about future activity. Usually one or two strains are changed in each year’s vaccine.

But committees from the World Health Organization and the United States Food and Drug Administration voted earlier this month to change all three strains in next season’s vaccine. It is the first time that all three strains were changed at once, Dr. Nancy Cox, an influenza expert at the C.D.C., said in a news conference on Feb. 22.

The centers recommendations for annual flu shots for adults include all Americans ages 50 and older; people with chronic lung, heart and other ailments; health care workers; and women who will be pregnant during the influenza season.

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